Fertility Treatments

Single Embryo Transfer?

BFF2011 wrote:

Hi- I am wondering if anyone else out there did a single embryo transfer (SET), especially an elective one? I just had mine today (8-cell, 3 days post retrieval).At my age (37), the guidelines state 2-3 embryos, but we weren’t comfortable risking multiples on our first try at IVF. In many parts of the Western world, SET is a more standard practice, especially since those countries have better insurance coverage. However, it seems to be really out of the norm in the US, and the doctors seemed surprised of our interest.

I’m not getting my hopes up since the chances of success are lower. Hopefully, the 7-cell from today will make it to blastocyst and be able to be frozen for another try, though. If anyone else is in a similar situation would love to hear about it. Not looking forward to this 2-week wait!

@BFF2011 We are planning to do a single transfer next month. I'm comfortable with twins but all of the risks during and after pregnancy is scary. I'm 34 and our dr is recommending one, especially with a five day transfer. Good Luck!!

W

Wishing2012

@BFF2011 I did a single embryo transfer and am currently 18 weeks pregnant. They actually wouldn't let me transfer more than one! And I'm currently 32. So not in my 20s. I did my IVF at Mt.Sinai in Toronto and they really promote SET. I did ask them if they would transfer 2 and they went through a million reasons why they strongly advised against it. I'm happy now because there are so many risks to the children when it comes to multiples but if the IVF hadn't worked, I would have been disappointed. It's hard because IVF is alot to put your body through so transfering more than one increases your chances of getting pregnant the first time. But at the same time, we all just really want a healthy child. I think you made a great decision but don't be discouraged if it doesn't work the first time. You really have to be prepared to see this as a process. I do think that the stats they gave me at the time were that one SET plus one frozen transfer = same odds as one 2 embryo transfer. Good luck!!!

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Ironbaby2012

@BFF2011 I'm 37 and we did an elective single embryo transfer. I am a physician and deliver babies do I am well aware of the risks involved when it comes to multiples (and the extra cost)! Our first eSET was a BFN but our second one was a BFP and I'm now almost 24 weeks pregnant. Think of each embryo as having a 50% chance of successfully implanting. Putting in more than one embryo doesn't increase the chance that any one embryo will implant but it does increase the chance of multiples. The average FET costs $2-4000, which is much less than than the cost of even a multiple pregnancy, never mind the cost of the babies when born. We had seven embryos frozen and were prepared to put all 7 in, one at a time, until we got our baby. We still have 5 left and will do eSET again when it's time to give our little goomba a sibling! Hope that helps...

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Icsibaby

@BFF2011 I did a set because I wasn't comfortable with twins, I mc that pregnancy, I was 29 at the time. Putting in two embryos doesn't increase your chance of getting pregnant and if ivf is paid for I would go that route again.

My insurance does not cover any IVF expenses. We just finished our first cycle but we are not transfering any, freezing all embryos due to an injury I need to heal from. My DH and I have been trying to decide if we should go with 1 or 2 FET as it will cost us about $4000 for each FET regardless of how many we transfer. I will be 40 when we transfer. After reading your post and discussing with my hubby we have decided to only transfer one at a time until we are sucessful. Thanks so much for sharing your thoughts!!!

I

Ironbaby2012

@Bellafurba We paid out of pocket for our IVF as well. It's very tempting to put 2 embryos back in because IVF is an emotionally and financially draining process, but you could eat up that $4k in 1-2 days in a NICU with premature twins. Plus, pregnancy is much more enjoyable when you're only carrying one baby!

W

Wishing2012

@Icsibaby I think I'm missing something here. I think transferring more than one embryo does increase your chances of getting pregnant the first time? If one embryo is a survivor and the other isn't, by transferring one, you may choose the one that is not a survivor and end up not pregnant. If you transfer both, you end up transferring the embryo that is going to survive and you end up pregnant. There is also a (small) risk with the freezing process still. From what I understood from my doctor, SET plus FET has odds only very slightly lower than transferring 2 embryos at once. Is someone saying this is not true?

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Icsibaby

@Wishing2012 From my re I understand that ur right u have more chance of picking the best embryo, but putting two embryos doesn't increase your chances for example if each embryo has a 50 pct chance then u it would add up, it's just a 50 pct chance... That's how he explained it to me.

B

Bellafurba

@Icsibaby You mean it DOESNT add up, right? Maybe I did not pay enough attention in my Statistics class but if each embryo has a 50% chance then your chances are 50% wether you transfer one or two. In this situation, two with a 50% chance don't equal 100%. Am I missing something?

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Ironbaby2012

@Bellafurba Each embryo has a 50% chance. It will have a 50% chance whether you put it in by itself or with another embryo. So if you have 2 embryos, the chances of you becoming pregnant are exactly the same if you put one in now AND one in later OR if you put them BOTH in now. That 50% is independent of any other embryo... Like flipping a coin. You do increase the chance of multiples by putting 2 in at once. Most labs have a >95% successful thaw rate so I wouldn't worry too much about a frozen embryo not surviving the thawing process... If it doesn't survive the thaw it was not likely to successfully implant anyway. Some people may argue that they don't want the extra expense of that additional FET it may take to get pregnant with that 2nd embryo if the first fails, but there is a lot of research that shows the prenatal care of a multiple pregnancy costs more than a second FET. That's why a single embryo transfer is becoming the standard of care in Europe and may ultimately become the standard in the U.S.

A

AmyVa

@BFF2011 I did single. I am 35. It took and my son will be one next week. Good luck :)

B

Bellafurba

@Ironbaby2012 Thanks so much for clarifying ironbaby!! This makes sense now. Don't know why it's not common practice everywhere to transfer one at a time. I thinks it better for mother and baby!

B

Bellafurba

@Ironbaby2012 That's very true. I have a relative who had a baby spend months in the NICU. Baby was very premature due to mom's incompetent cervix (gosh I hate that term) and was just over 1 lb. They had so many medical bills for both mom (she spent a month in the hospital before baby was born) and baby, that they actually went bankrupt. It was very sad. We know multiples tend to be premature, so we'd hate to put ourselves and babies through this.

Since we were paying for everything out of pocket, we transferred three and now have twins. It was all or nothing for us. We weren't going to do it again and the embryos were all fair, but nothing great... Well, looks like two were. That being said, if insurance paid for ivf, we would have done a set.

Thank you to everyone for your responses. It is really helpful to hear from others going down this path and know that I am not alone. At my clinic, almost all the doctors and nurses have been very discouraging about SET for someone who is 37, including during my transfer yesterday. Even after all the research I did, in the moment I still had some doubts about not putting 2 in. It’s hard in such an emotional situation to be disciplined and analytical about one’s choices.

In terms of success rates, I was quoted by my clinic as about 30% probability with SET and about 50% probability with DET (with DET carrying a risk of about 25% twins). I think the odds are definitely lower with SET, but have also read that paper mentioned in this thread that cumulative success rates of SET followed by FET are comparable to DET.

There are good articles on the ASRM and CDC ART section about SET which are easily found online. None of these considerations were ever mentioned to me by a doctor. I worry that there is a little bit of misaligned incentives at some clinics since clinic data is publicly posted on the CDC ART website. So, everyone can see a clinic’s stats for success by age bracket, without being broken down by how many embryos were put in to get that rate. There is a line for average # embryos as well as % multiples, but am sure the numbers people pay most attention to are success rates.

My situation is that I have good coverage for about 3 IVF cycles and have a very active toddler (after 4 rounds of IUI), so going from 1 to 3 young children would mean 2 new cars, reconfiguring the house, strain on household, over 3K in daycare a month, etc.I think I have the resolve to go through another round of SET if this one fails, but it will be a struggle not to cave in and consider DET after that. Everyone’s personal circumstances are different, and I think DET is a very valid choice for some. My issue is that there is just not enough education on options and implications for patients. There are long-term and short-term costs to everything, some of which are financial and some of which are emotional.

Thanks again for everyone's kindness. I was apprehensive about posting on message boards, but appreciated the thoughtful and considerate responses. Good luck to everyone!

M

Myboo99

@mcgeelisha My RE told us last week that they usually do 2 but it's ultimately up to the patient. She also said its 65% for det with 25% twin rate & set is only 45% with a 3% twin rate. Although we aren't starting til Jan I guess I really hadn't thought about it. I just assumed I'd do 2 cuz we're oop & I have adrenal issues so not sure how many rounds of meds I could take. But the thought of twins scare me to death! They're almost always preemies which require a lot of extra medical expenses & risks to the children as well as me in pg'y. It is such a tough decision but even tougher when the drs aren't supporting what you really want. But all in all no matter what anyone chooses I hope it works for everyone & I certainly have some thinking to do!!

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Icsibaby

@Myboo99 Myboo me too, the thought of twins is hard but since we are paying out of pocket and I did a set the first two times last year (bfn) and I put in two in April and I'm putting in two this time god willing, Ive made my husband swear black and blue that if it's twins he will be even more helpful than he promises to be, I think after 3 yrs we are in a place to embrace whatever comes our way. Baby dust to all of us!

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